Results for "Coughing"

3.1.2 Coughing in horses 2

3.1.1 Coughing in horses 1

Dyspnea & Coughing (Quiz 3)

Chapter 7:6 Study Guide NERVOUS SYSTEM P179-187 Nervous System-complex, highly organized system that coordinates all the activities of the body. *The basic structural unit of the nervous system is the neuron, or nerve cell. It consists of a cell body containing:  Nucleus  Nerve fibers called dendrites (carry impulses toward the cell body)  Single nerve fiber called axon (carry impulses away from the cell body) Many axons have a lipid covering called a myelin sheath, which increases the rate of impulse transmission and insulates and maintains the axon. The axon of one neuron lies close to the dendrites of many other neurons. The spaces between them are known as synapses. Special chemicals, called neurotransmitters, located at the end of each axon allow the nerve impulses to pass from one neuron to another. Nerves are a combination of many nerve fibers located outside the brain and spinal cord. Meninges are membranes or protective lining that covers the brain and spinal cord. Afferent, or sensory, nerves carry messages from all parts of the body to the brain and spinal cord. Efferent, or motor, nerves carry messages from the brain and spinal cord to the muscles and glands. Associative, or internuncial, nerves carry both sensory and motor messages. There are two main divisions to the nervous system: 1. 2. Central nervous system: consists of the brain and spinal cord Peripheral nervous system: consists of the nerves. A separate division of the peripheral nervous system is the autonomic nervous system. This system controls involuntary body functions. *Brain-mass of nerve tissue well protected by membranes and the cranium, or skull. The main sections include:  Cerebrum-the largest and highest section of the brain. Responsible for: reasoning, thought, memory, speech, sensation, sight, smell, hearing, and voluntary body movement.  Cerebellum-section below the back of the cerebrum. Responsible for: muscle coordination, balance and posture, muscle tone.  Diencephalon-section between the cerebrum and midbrain. o Thalamus-acts as a relay center and directs sensory impulses to the cerebrum. o Hypothalamus-regulates and controls the autonomic nervous system, temperature, appetite, water balance sleep and blood vessel constriction and dilation. Also involved in emotions such as anger, fear, pleasure, pain and affection.  Midbrain-the section located below the cerebrum at the top of the brain stem. Responsible for conducting impulses between brain parts and for certain eye and auditory reflexes.  Pons-located below the midbrain and in the brain stem. Responsible for conducting messages to other parts of the brain; for certain reflex actions including chewing, tasting, and saliva production; and for assisting with respiration.  Medulla oblongata-the lowest part of the brain stem. Connects with the spinal cord and is responsible for regulating heartbeat, respiration, swallowing, coughing, and blood pressure. The spinal cord continues down from the medulla oblongata and ends at the first or second lumbar vertebrae. *The meninges are three membranes that cover and protect the brain and spinal cord. 1. 2. 3. Dura mater-thick, tough, outer layer Arachnoid membrane-delicate and web like Pia mater-closely attached to the brain and spinal cord and contains blood vessels that nourish the nerve tissue. The brain has four ventricles, hollow spaces that connect with each other and with the space under the arachnoid membrane. The ventricles are filled with a fluid called cerebrospinal fluid. This fluid circulates continually between the ventricles and through the subarachnoid space. It serves as a shock absorber to protect the brain and spinal cord. It also carries nutrients to some parts of the brain and spinal cord and helps remove metabolic products and wastes. After circulating, it is absorbed into the blood vessels of the dura mater and returned to the bloodstream through special structures called the arachnoid villi. The peripheral nervous system consists of the somatic and autonomic nervous systems. The somatic nervous system consists of 12 pairs of cranial nerves and their branches and 31 pairs of spinal nerves and their branches. Some of the cranial nerves are responsible for special senses such as sight, hearing, taste, and smell. The Autonomic nervous system is an important part of the peripheral nervous system. It helps maintain a balance in the involuntary functions of the body and allows the body to react in times of emergency. *There are two divisions to the autonomic nervous system: Sympathetic nervous system: prepares the body in times of emergencies. Prepares the body to act by increasing heart rate, respiration, and blood pressure and slowing activity in the digestive tract. This is known as the fight or flight response. Parasympathetic nervous system: After the emergency, this slows down the heart rate, decreases respirations, lowers blood pressure and increases activity in the digestive tract. Cerebral Palsy is a disturbance in voluntary muscle action and is caused by brain damage. Lack of oxygen to the brain, birth injuries, prenatal rubella, and infections can all cause cerebral palsy. Cerebrovascular Accident or CVA (stroke) occurs when the blood flow to the brain is impaired, resulting in a lack of oxygen and a destruction of brain tissue. CVA includes loss of consciousness; weakness or 1. 2. paralysis on one side of the body (hemiplegia); dizziness; dysphagia (difficulty swallowing); visual disturbances; mental confusion; aphasia (speech and language impairment); and incontinence. When a CVA occurs, immediate care within the first three hours can help prevent brain damage. Treatment with thrombolytic or “clot-busting” drugs such as TPA (tissue plasminogen activator) can dissolve the blood clot and restore blood flow to the brain. Aphasia is a speech or language impairment. There are different types. ALS is amyotrophic lateral sclerosis. Also called Lou Gehrig’s disease. This is a chronic degenerative neuromuscular disease. The cause is unknown. Carpal tunnel syndrome is a progressive, painful condition of the wrist and hand. It occurs when the median nurse is pinched or compressed. Concussions are traumatic brain injuries, usually from a blow to the head by an accident, injury or fall. The brain slides back/forward and forcefully hits against the skull. Think of it like a bruise on the brain. Encephalitis is an inflammation of the brain and is caused by a virus, bacterium, or chemical agent. Epilepsy or seizure syndrome is a brain disorder associated with abnormal electrical impulses in the neurons of the brain. Hydrocephalus is an excessive accumulation of cerebrospinal fluid in the ventricles and, in some cases, the subarachnoid space of the brain. It is usually cause by a congenital (at birth) defect, infection, or tumor that obstructs the flow of cerebrospinal fluid out of the brain. The condition is treated by the surgical implantation of a shunt (tube) between the ventricles and the veins, heart, or abdominal peritoneal cavity to provide for drainage of the excess fluid. Meningitis is an inflammation of the meninges of the brain and/or spinal cord and is caused by a bacterium, virus, fungus, or toxins such as lead and arsenic. Multiple Sclerosis (MS) is a chronic, progressive, disabling condition resulting from a degeneration of the myelin sheath in the central nervous system. Neuralgia is nerve pain. Inflammation, pressure, toxins, and other disease cause it. Paralysis usually results from a brain or spinal cord injury that destroys neurons and results in a loss of function and sensation below the level of injury. Hemiplegia is paralysis on side of the body and is caused by a tumor, injury, or CVA. Paraplegia is paralysis in the lower extremities or lower part of the body and is caused by a spinal cord injury. Quadriplegia is paralysis of t harems, legs, and body below the spinal cord injury. Parkinson’s disease is a chronic, progressive condition involving degeneration of brain cells, usually in persons over 50 years of age

Intro to Herbs: Herbs that Transform Phlegm and Stop Coughing

Ch. 6 Herbs that Transform Phlegm and Stop Coughing

Breathing and Coughing Techniques

DDx 2 dyspnea and coughing

Lecture 4: Pulmonary Rehabilitation Airway Clearance Techniques (Coughing and Postural Drainage)

Coughing SA

CBL 5: The Coughing Cavalier

mucus & coughing

CBL 3: The Coughing Calves

Herbs that Stop Wheezing and Coughing

DEFINITION • Asthma: Chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction. • Chronic inflammation results in airways hyperresponsiveness (AHR) to provocative exposures • Management aims: 1. Reduce proinflammatory environmental exposures and 2. DAILY anti-inflammatory medications (ie. corticosteroids) and 3. Control any comorbidities that may worsen asthma AETIOLOGY • Cause not fully determined • Combination of environmental exposures and inherent biological and genetic vulnerabilities • **Causal environments: Inhaled allergens, viral RTIs, chemical/biological air pollutants/irritants eg. tobacco smoke. o Exposure to these in predisposed host result in prolonged pathogenic inflammation and aberrant repair --> Lung dysfunction develops. o This abnormal growth and development in early life leads to abnormal airways at mature age GENETICS • More than 100 gene loci linked to asthma. • Loci contain • Other genes: ENVIRONMENT • Injurious/severe LRTI of the airways that manifest as *pneumonia and *bronchiolitis are risk factors for persistent asthma. • Other infections/Microbes • Allergens – Inhalant allergens > food allergens • Irritants/Pollutants e.g. Tobacco smoke • Stress RISK FACTORS (Must Know) See box -> (M > F) -> Lecture: “ASTHMA PREDICTIVE INDEX (API)” - Tucson cohort 1980-present - >/= 4 eps of wheeze + 1 major OR 2 minor predicts asthma APPLIES TO CHILDREN <= - *MAJOR: 1. Parental asthma, 2. Atopic dermatitis (eczema), 3. Inhalant allergen sensitization - MINOR: 1. Eosinophilia > 4%, 2. Wheezing outside of colds, 3. Food allergen sensitization, 4. Allergic rhinitis POINTS Approximately 80% of all asthmatic patients report disease onset prior to age 6!! - BUT only a minority of children who experience recurrent wheezing go on to persistent asthma - Maternal asthma is the single most important risk factor for asthma development 2 main types of childhood asthma: 1. Recurrent wheezing 2. Chronic asthma PATHOGENESIS Airway obstruction in asthma results from numerous pathologic processes: • In small airways, airflow is regulated by smooth muscle encircling the airways lumens – bronchoconstriction of these bronchiolar muscle bands restricts and blocks airflow (Parasympathetic system stimulates bronchoconstriction) • ALSO, a cellular inflammatory infiltrate AND exudates containing mainly eosinophils, can fill and obstruct airways AND induce epithelial damage and desquamation into the airways lumen. • ALSO, helper T lymphocytes (CD4) and other immune cells produce proallergenic, proinflammatory cytokines (IL-4, 5 and 13) that mediate the inflammatory process. ALL CONTRIBUTE TO AIRFLOW OBSTRUCTION (LOOK AT EACH AND JUST OBVIOUSLY SEE HOW) CLINICAL MANIFESTATIONS AND DIAGNOSIS ***NOTE FROM LECTURE: The most likely diagnosis in children with recurrent wheezing is asthma, regardless of the age of onset, evidence of atopic disease, precipitating causes, or frequency of wheezing MOST COMMON CHRONIC SYMPTOMS: • Intermittent DRY COUGHING • EXPIRATORY WHEEZE Other symptoms in older children/adults: • Shortness of breath • Chest tightness **NB**: The respiratory symptoms are WORSE AT NIGHT!! Others are subtle/nonspecific: Limited physical activity, general fatigue (may be due to sleep disturbance) • ***MUST ASK ABOUT PREVIOUS BRONCHODILATOR USE IN HISTORY!!: o Symptomatic improvement with treatment supports asthma diagnosis! o BUT lack of improvement with bronchodilator/corticosteroid therapy is inconsistent with asthma and should prompt consideration of “ASTHMA-MASQUERADING CONDITIONS” • ***MUST ASK ALL Triggers***: Physical exertion, hyperventilation (laughing), cold or dry air, airway irritants/allergens (incl smoking at home, pets etc), respiratory infection (induce airway inflammation – eg. RSV, rhinovirus, adenovirus, influenza, parainfluenza, mycoplasma pneumoniae, chlamydia pneumoniae). ENVIRONMENTAL HISTORY IS VITAL • **Ask about risk factors: SEE RISK FACTORS ABOVE AND OTHER DIFFERENTIALS OF WHEEZE From lecture: HISTORY FOR A WHEEZING PATIENT: o Age of onset o Course of onset (Acute vs. chronic) o Cough o Shortness of breath o Cyanosis o Chest pain o **Exercise-induced symptoms o Postnasal drip o Snoring o Spitting up o Greasy stool (cystic fibrosis)? o **Eczema o Choking o Triggers o Cold air o Allergic rhinitis o Weight loss o Recurrent infections o Birth history o Environmental history o Smokers at home o Number of siblings o Occupation of inhabitants at home o Pets o TB exposure o Worms o ***Family history of Atopy/Asthma o ***Past use and response to bronchodilators o Food allergies o Co-morbid conditions History suggestive of asthma o Intermittent episodes of wheezing o Seasonal variation o Family history of asthma and/or atopy o Good response to asthma medications o Positive asthma predictive index **History suggestive of a diagnosis other than asthma o Poor response to asthma medications/bronchodilators o History of neonatal or perinatal respiratory problems o Wheezing since birth - congenital abnormality o Associated with feeding or vomiting o History of choking associated with cough & SOB o Poor weight gain o Recurrent ear or sinus infections o Wheezing with little cough - Mechanical cause of obstruction- small airways, airway malacia o Symptoms vary with position (TM) o Progressive dyspnea, tachypnea, exercise intolerance & failure to thrive suggest interstitial lung disease Examination (See Notes on wheezing for general wheezing examination) • ***Chest findings are often normal!! – Ask for deeper breaths -> May elicit wheezing In extremis -> Airflow may be so limited that wheezing cannot be heard DIFFERENTIAL DIAGNOSIS [**CLASSIFY: Upper vs. Middle vs. Lower respiratory tract conditions**] [ALSO: Extraluminal compression vs. Intraluminal obstruction vs. Intrinsic change in airway dimension] Also depends on the age group (see lecture) Other common causes of intermittent chronic coughing --> GER, rhinosinusitis SEE TABLE BELOW - * = More common ones DIFFERENTIAL DIAGNOSIS OF CHILDHOOD ASTHMA UPPER RT CONDITIONS MIDDLE RT CONDITIONS LOWER RT CONDITIONS - Allergic rhinitis * - Chronic rhinitis * - Sinusitis * - Adenoidal or tonsillar hypertrophy - Nasal foreign body - Laryngotracheobronchomalacia * - Laryngotracheobronchitis (e.g., pertussis) * - Chronic bronchitis from environmental tobacco smoke exposure * - Vocal cord dysfunction * - Foreign body aspiration * - Laryngeal web, cyst, or stenosis - Vocal cord paralysis - Tracheoesophageal fistula - Vascular ring, sling, or external mass compressing on the airway (e.g., tumor) - Toxic inhalations Viral bronchiolitis * Gastroesophageal reflux * Bronchopulmonary dysplasia (chronic lung disease of preterm infants) Pneumonia Pulmonary oedema (e.g., congestive heart failure) Causes of bronchiectasis: Cystic fibrosis Immune deficiency Allergic bronchopulmonary mycoses (e.g., aspergillosis) Chronic aspiration Immotile cilia syndrome, primary ciliary dyskinesia Bronchiolitis obliterans Interstitial lung diseases Hypersensitivity pneumonitis Pulmonary eosinophilia, Churg-Strauss vasculitis Pulmonary hemosiderosis Tuberculosis Medications associated with chronic cough: Acetylcholinesterase inhibitors β -Adrenergic antagonists Angiotensin-converting enzyme inhibitors LABORATORY FINDINGS 1. PULMONARY FUNCTION TESTS (Spirometry and Peak flow) POINT: ‘Forced expiratory airflow measurement’ helpful in diagnosis and monitoring efficacy of therapy A. Spirometry is helpful as an objective measure of airflow limitation o **Valid spirometry measurements depend on a patient’s ability to perform a full, forceful, prolonged expiration, usually feasible in children > 6 yrs. old. Reproducible spirometric efforts are an indicator of test validity; if the FEV 1 (forced expiratory volume in 1 sec) is within 5% on 3 attempts, then the highest FEV 1 effort of the 3 is used Normative values for FEV 1 have been determined for children on the basis of height, gender, and ethnicity o Because asthmatic patients typically have hyperinflated lungs, FEV 1 can be simply adjusted for full expiratory lung volume — the forced vital capacity (FVC) — with an FEV 1/FVC ratio. o BUT these measures alone are NOT diagnostic of asthma as numerous other conditions can cause airflow reduction Bronchodilator response to an inhaled β -agonist (e.g., albuterol) is > in asthmatics than nonasthmatics; an improvement in FEV 1 ≥ 12% or > 200 mL is consistent with asthma. IMPORTANT TABLE (NELSON’S) B. Peak expiratory flow (PEF) monitoring devices provide simple and inexpensive home-use tools to measure airflow and can be helpful in a number of circumstances. Patients must practice over 2-3 weeks to determine a “personal best”, preferably at times when they a not symptomatic • Peak flow rate monitoring can be accurately performed by most patients > 5 years • ** PEFR < 80% predicted for height/patient’s personal best should trigger the administration of an inhaled short-acting beta2 -agonist • A PEFR < 50% of the patient’s personal best should trigger both administration of an inhaled short-acting beta2 -agonist AND immediate medical attention SEE MY FULL NOTES ON PEFR NOTE WELL: PEFR and FEV1 are different. Forced expiratory volume over 1 second (FEV1) is a dynamic measure of flow used in formal spirometry. It represents a truer indication of airway obstruction than does peak flow rate. Although peak flow rate usually correlates well with FEV1, this correlation decreases in patients with asthma as airflow diminishes. 2. Radiology The findings of chest radiographs (PA and lateral views) in children with asthma often appear to be normal, aside from subtle and nonspecific findings of hyperinflation (flattening of the diaphragms) and peribronchial thickening CXR: • Hyperinflation (Flattened ribs and diaphgram, Increased number of ribs over hemidiaphragm, Right diaphragm same level as left) • Flattened hemi-diaphragms • Peribronchial cuffing • Atelectasis Chest radiographs can be helpful in identifying abnormalities that are hallmarks of asthma masqueraders (aspiration pneumonitis, hyperlucent lung fields in bronchiolitis obliterans), and complications during asthma exacerbations (atelectasis, pneumomediastinum, pneumothorax). TREATMENT **MUST SEE ENTIRE UHWI OFFICIAL EMED DOCUMENT** • SEE GINA GUIDELINES • SEE SUMMARY OF THE STEP UP AND DOWN APPROACH FROM A CONCISE SOURCE!! • MUST SEE UHWI OFFICIAL EMED DOCUMENT AND GINA FOR MANAGEMENT OF EXACERBATION ***ASTHMA IS A CHRONIC CONDITION THAT IS OFTEN BEST MANAGED WITH DAILY ICS CONTROLLER MEDICATION as monotherapy or with adjunctive therapy*** ***NOTE WELL: Remember patient education AND control of environmental factors AND comorbidities (eg. GER, rhinitis, sinusitis etc.)*** NELSON’S: During initial patient visits, a basic understanding of the pathogenesis of asthma (chronic inflammation and AHR underlying a clinically intermittent presentation) can help children with asthma and their parents understand the importance of recommendations aimed at reducing airways inflammation. It is helpful to specify the expectations of good asthma control resulting from optimal asthma management. Explaining the importance of steps to reduce airways inflammation in order to achieve good asthma control and addressing concerns about potential adverse effects of asthma pharmacotherapeutic agents, especially their risks relative to their benefits, are essential in achieving long-term adherence with asthma pharmacotherapy and environmental control measures. GINA (GLOBAL INITIATIVE FOR ASTHMA) GUIDELINE Based on GINA guidelines, must use this table to determine level of control, which will determine when to “Step-up” management, using the table on the next page

Coughing and sneezing most annoying behavior on trains

Herbal Pairs That Stop Coughing and Resolve Phlegm

Herbs that Relieve Coughing and Wheezing

Approach to the coughing horse

Respiratory System